*Pleasure* to make your acquaintance

The new neurology senior resident comes into the room, and you've never laid eyes on him before. He takes your coat off the chair you've been sitting in for half an hour, and says "that's my chair."

He then proceeds to dress you down (in front of everybody) over a note you wrote five days ago on a patient he has yet to lay eyes on (yet he can't even tell you the patient's name). Yeah, it's a real pleasure to meet you. I can't wait to work with you...jerk. 

Neurology...DDDDDDDONE

Finished my neurology rotation. I must say I thoroughly enjoyed what I learned and working with this particularly attending. I didn't care so much for his preferred hours. I'm an early bird. I don't mind waking up at six to get to work by seven, or earlier, and leave so I can eat dinner at a reasonable hour.  Dr. Brain is a night owl. He prefers coming in at 11:30 and staying until 8 or later. That means we stayed with him until 8, 8:30 most nights. I felt like I learned A LOT. I got my neuro exam time down to less than thirty minutes. The first time it took me well over an hour. My attending offered me a letter of recommendation. I didn't ask for one. I had planned to, but he offered before I had what I thought was the appropriate chance. So woohoo!

Next up for me is a two week break (what WILL I do with myself??) and then I have three more rotations. I'm going back to Chicago Hope Hospital, and I'm looking forward to it. Chicago Memorial Hospital was a good place to learn, but the nurses there, particularly in the ICU can be real curmudgeons. 

Let's Geek Out!!

Neurology is rolling right along. Yesterday I was basically one-on-one with my attending because my partner took two (yes TWO hours) to see and write a report on a patient who is for all intents and purposes braindead. I have many questions...but moving along. The first patient had an array of symptoms that were fascinating to observe as a student. He had a present Babinski sign on the L, a L ankle clonus, and diminished L knee reflex. I became unnecessarily excited when I observed the Babinski: "Um, doctor, I think this is an upgoing Babinski. Do you want to verify?" I was indeed! Same with the clonus. I didn't see it, but felt the ankle jerk an extra time after the initial reflex, which I initially didn't think anything of, but after a second I asked the doctor to verify that as well, and indeed, I was paying close attention! Go me??

Later, we had a patient who has a history of thrombotic thrombocytopenic pupura. She had significant neurological damage. She had a rubral tremor, and noticeable cognitive impairment. Getting her to do Serial 3's (1, 4, 7, 10, 13...etc), you'd think I was asking her to do quantum mechanics. So all in all the doctor said I did very well with those cases.

Fast forward to today. We had a patient come in who on top of being hard of hearing didn't speak English as her first language (not unusual). We knew ahead of time that she had a pontine lesion, so the attending asked us to pay special attention to her cranial nerves. I noticed what I found out to be square wave jerks in her eyes. The doctor did not notice that immediately while my partner was doing the exam, and appreciated me calling it to his attention. Also this morning we had a patient who was known to the doctor. He had me examine her cold and to find her abnormality. I correctly diagnosed her problem as an ulnar nerve neuropathy. She had a noticeable left palpebrae that wasn't equal to the right, and I noticed she also had a slight left-sided mouth droop while the doctor was addressing a sensory complaint in her arm. I was able to bring that to his attention. I felt unnecessarily accomplished, and totally geeked out. 

I'll leave with some awesomely bad jokes from my attending:

Did you hear about the Invisible man ? He married an invisible woman. Their kids aren't much to look at.

Disgruntled patient who just happens to be an NRA member: "If another doctor tells me there's nothing wrong with me I'll kill him."

Doc: "There's definitely something wrong with you." 

A big giant WHY...

This morning my attending asked my partner and I to evaluate a seizure patient...but wait!!! The patient is sedated. Hope the attending doesn't mind ten pages of "unable to assess."


Follow up!!: As I was reading through the previous notes (the patient has been in the hospital for quite a while) I came across a real gem. According to a wonderfully written progress note: "Pt had this morning that lasted for 30 min..." Pray tell what did he have? Seizures? Vomiting? Headache? Fits of rage? Priapism? I'm all ears doc...

Today's Observations

1. It's 85 degrees, unless you're from Saudi Arabia and find that cold, why are you wearing a scarf??

2. Anyone attempting a left turn at Addison and Clark on Cubs game day needs their head examined. And deserves to be tazed for backing up traffic even more...because you know they're never going to get to actually make that turn.

3. I like neurology. My attending says I'm doing well and has allowed me to do exams on my own. However, I was thinking about going into neurology before this rotation. I find it interesting, but I am no longer considering neurology.

Neurology

This week I started my neurology rotation. It's been interesting, but also a lot of work. I don't really mind it. I'm not crazy about the hours, however. They aren't long, but they are late, so they might as well be long. I haven't been getting home until after eight most evenings. I'm accustomed to getting up and out early, and doing my errands in the evening. This means I have to reverse that pattern for a few weeks, which is kind of weird.

The doctor is nice, but sometimes the way he talks makes him come across as a bit of a jerk. For example, yesterday he was quizzing us about random neurological signs, and I hadn't the foggiest clue what the sign was. I asked him if he could spell "Lhermitte's" sign, and he just replied "No."...Thanks dude. I've never heard of that, or if I have it has long been forgotten.

I'll be the first to admit neuroanatomy was not my favorite or best subject. I think you have to be a witchdoctor to understand a lot of the pathways and crossings.

Yesterday we had neurology clinic, and we have several new patients. The first patient of the day, the doctor said "Okay luckyone, you're going to do the exam. Unless you would prefer me to do it, this might be a difficult case." Well, of course I'm not going to back down from that. Sink or swim I told him I would be fine to do the exam, even though I was indeed nervous. I started taking my history, and not too long after I started he suggested that I not ask quite so specific questions, which threw my rhythm off a bit as I was trying to ensure that I didn't get reprimanded for asking "too specific questions." Nerves, but oh well. I'll get there. So, I was trying to concentrate on asking broader questions, and it needed a bit of work. Some of the things he noted that I didn't ask or facts that I didn't obtain I recall indeed obtaining. Perhaps not the proper way or to his liking, but I did get that information.

My exam was fine, I think. A bit unorganized, but I have never done a complete neuro exam before and I didn't want to do it by the list because the order looked a bit weird to me. Maybe I'm slightly dyslexic, but I stay on track easier if I do things in groups. I only had to be corrected on one task, and that was just a brainfart.

QOTD

"I had a patient once who tried to commit suicide by shooting herself in the neck. She missed everything. When I asked her about the pain, she described it as a shooting pain. I had to excuse myself from the room to avoid laughing."

Moral of the story: when you attempt suicide either make it count, or at least work on your descriptors.